An Experiment With Concierge Medical Care

In Palm Beach, doctors donate high-priced healthcare to low-income people with chronic disease.

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You'd expect to find a concierge medical practice in Palm Beach, Fla. These high-touch, personalized practices that give patients 24/7 access to doctors who keep close tabs on their care generally cost a few thousand dollars a year. That's more than many people who are already struggling just to cover their healthcare premiums and copayments can afford.

So I was surprised to learn of a Florida concierge practice that's offering its 24-karat care free to a select group of 25 people with incomes at 200 percent of the poverty level or less ($42,400 for a family of four). It's all happening under the auspices of the Palm Beach County Medical Society's Project Access, which provides nonemergency medical care to hundreds of residents in this mostly rural county, people who don't show up in the society pages and aren't well to do.

Now MDVIP, a concierge company based in Boca Raton that charges patients $1,500 annually for its personalized services, has begun a pilot program with Project Access to provide its services gratis to people with chronic conditions. Edward Goldman, the CEO of MDVIP who's something of a preventive care proselytizer, says he wants to show that the hands-on approach can be successful for many types of patients. Noting that there's been a significant drop in hospitalizations among MDVIP patients, he says, "We felt that the results we were seeing were not just because we were dealing with suburbanites."

The company hopes to expand the pilot program to 200 people in Palm Beach County in June, all of whom would get the full MDVIP treatment at no cost, including comprehensive assessment and monitoring of their health conditions and education to teach patients to manage them. Goldman says he expects it will take several years to get them on the right track, at which point the patients will leave the program. MDVIP currently has about 240 affiliated doctors in 23 states and the District of Columbia. Assuming all goes well in Florida, Goldman says he hopes to expand the Project Access work to more of the 20-some communities around the country where the program operates.

It's interesting in a "dog bites man" way to find concierge doctors who are donating their time to help people without a lot of money get care. One of the criticisms of this growing type of niche practice is that by catering to people who can afford to pay extra for healthcare, they widen the already troubling gap between healthcare haves and have nots. Concierge doctors typically reduce the size of their practices from a few thousand patients to perhaps 500, allowing them to spend more time with the ones they have. Unfortunately, this leaves patients who can't afford the monthly fee with fewer available doctors and less access to care.

Meanwhile, charity care has been on the decline for years: Between 1997 and 2004, the proportion of physicians who provided any such care dropped 8 percentage points, to 68 percent, according to the Center for Studying Health System Change.

MDVIP deserves kudos for its efforts thus far, and if it expands the program further, all the better. But it's not going to put a dent in the 47 million uninsured in this country, nor improve the healthcare access of more than a fortunate few. Concierge practices are by definition exclusive, more about shutting people out than welcoming them in. "The whole point is to improve the doctor/patient ratio," says Arthur Caplan, chair of the department of medical ethics at the University of Pennsylvania. "So they're not going to do too much to reach out to the poor."

What do you think? If you could afford to sign up with a concierge practice, would you?